24 Aug Aging, Sarcopenia, and the Role of Nutrition
Sarcopenia, the progressive reduction of lean muscle mass and associated increase in fat mass, is one of the most consistent changes that occurs with aging. After the age of 35 years, a healthy person loses muscle mass at a rate of 1-2 percent per year, and suffers on average 1.5 percent decline in overall strength. These numbers climb steadily to an annual loss of over 3 percent after age 60. The muscle cross-sectional area of the thigh, for example, decreases with about 40 percent between the ages of 20 and 60, and the scale of decline in fat-free mass is twice as great in men than in women (Calvani et al.) A sedentary life style only adds to the rate of muscle loss.
This decline in muscle mass and strength with age has been known for many years: the term sarcopenia (in Greek, “sarx” means flesh and “penia” means loss) was first used by Irwin Rosenberg in 1989. Since then, researchers have further defined the condition as age-related loss of muscle mass, and shown how it results in decrease of strength, metabolic rate, aerobic capacity, and overall functional capacity. It limits the body’s ability to cope with the stress of a major illness or injury and may influence age-related osteoporosis (Russo et al., 2000; Walsh et al.,2006). Sarcopenia is now known to be a key precursor to the development of frailty, and a powerful predictor of late-life disability (Roubenoff; Calvani). With an exponential increase in publications on sarcopenia in the late 1990s and early 2000s, researchers now contend that “Sarcopenia has ‘come of age’ and should be recognized as a preventable and treatable condition among geriatric patients” (International Working Group on Sarcopenia).
Sarcopenia is a part of normal aging–it even occurs in elite athletes–and with the number of elderly predicted to grow exponentially over the next few decades, researchers are increasingly focusing on both the causes and prevention of this decline in muscle loss. Studies show that a combination of physical exercise and adequate nutritional intake are most effective in preventing and treating sarcopenia:
At present, no pharmacological treatment exists that is able to definitely halt the progression of sarcopenia. Likewise, no pharmacological remedies are yet available to prevent the onset of age-related muscle wasting. In this scenario, the combination of nutritional interventions and physical exercise appears to be the most effective strategy presently available for the management of sarcopenia (Calvani et al.)
To research the role of nutrition in the prevention and management of sarcopenia, the Society for Sarcopenia, Cachexia, and Wasting Disease convened an expert panel in 2010 to develop nutritional recommendations. The panel, besides acknowledging the central role of physical exercise, highlighted the importance of a sufficient intake of calories and several nutrients, including proteins and amino acids, vitamin D, and creatine. In addition, a report from the Health, Aging, and Body Composition Study has recently highlighted the importance of protein intake for the preservation of lean body mass in old age (Calvani et al.).
Further research reviewed the roles of protein, acid-base balance, vitamin D, calcium, and other minor nutrients like B vitamins. These studies conclude that a loss of fast twitch fibers, glycation of proteins, and insulin resistance plays an important role in the loss of muscle strength and development of sarcopenia. Protein intake plays an integral part in muscle health with an optimal intake of 1.0-1.2 g/kg of body weight per day for older adults. There is also a moderate relationship between vitamin D status and muscle strength. Chronic ingestion of acid-producing diets appears to have a negative impact on muscle performance, and decreases in vitamin B12 and folic acid intake may also impair muscle function through their action on homocysteine. Overall, these studies conclude that adequate nutritional intake and an optimal dietary acid-base balance are important elements of any strategy to preserve muscle mass and strength during aging (Mithal et al.)
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Calvani, Riccardo et al. “Current Nutritional Recommendations and Novel Dietary Strategies to Manage Sarcopenia.” The Journal of Frailty and Aging 2.1 (2013): 38–53.
International Working Group on Sarcopenia. “Sarcopenia: An Undiagnosed Condition in Older Adults. Current Consensus Definition: Prevalence, Etiology, and Consequences.” Journal of the American Medical Directors Association 12.4 (2011): 249–256.
Mithal et al. “Impact of Nutrition on Muscle Mass, Strength, and Performance in Older Adults.” Osteoporosis Int. 2012, Dec 18.
Rizzoli, René, et al. “Quality of Life in Sarcopenia and Frailty.” Calcified Tissue international 93.2 (2013): 101–120.
Roubenoff, R. “Sarcopenia and its Implications for the Elderly.” European Journal of Clinical Nutrition 54 (2000): 40-47.
Russo CR, Ricca M, Ferrucci L. “True Osteoporosis and Frailty-related Osteopenia: Two Different Clinical Entities. Journal of American Geriatric Society 48 (200): 1738–1739.
Walsh MC, Hunter GR, Livingstone MB. “Sarcopenia in premenopausal and postmenopausal women with osteopenia, osteoporosis and normal bone mineral density.” Osteoporosis Int 17 (2006): 61–67.